Priority: Eliminate institutional and structural racism in internal MDPH programs, policies, and practices to improve maternal and child health.

 

Objective 1 (SPM 3). By 2025, increase to 95% from baseline (64% in 2019) the percent of BFHN and BCHAP staff who have used any racial equity tool or resource in their work.

Racial Equity Movement (REM)

A continued priority will be to provide and improve upon opportunities for MDPH staff to engage in ongoing learning and dialogue to promote common language, shared understanding, and authentic support for a public health framework centered on racial equity. Formal opportunities will include two-day trainings, affinity groups, lunch and learn discussions, and town hall meetings.

 

MDPH will continue to contract with the Racial Equity Institute (REI) to offer ongoing racial equity trainings to staff and will continue to offer racial equity labs for staff who have completed a two-day training to further their racial equity practice. The labs will focus on diagnosing the specific challenges staff may face in their program or office, looking at the problem from a structural lens. They will explore topics such as: head/heart integration, racial justice PDSA (plan, do, study, act) support, Racial Equity Impact Assessments, solving problems collectively using capsules, pushback circles for managing difficult conversations, and group dynamics. The REM workgroups will continue developing and implementing strategies to support equity-focused systems change. 

 

Increasing staff use of racial equity tools was an area of growth identified in the 2019 BCHAP/BFHN Racial Equity Survey and is used to measure progress on this priority. MDPH plans to implement a similar survey Department-wide, due to the growth of the REM beyond BFHN and BCHAP. MDPH hired a consultant to facilitate survey development and analysis. The survey development process has included consultation with MDPH staff to consider the unique needs and starting points of different bureaus, the importance of maintaining consistent questions from previous racial equity surveys, and careful planning about how the data will be used. The survey will assess attitudes, approaches, and perceived barriers and needs related to racial equity. The data will be used to guide the implementation of the Department’s strategic plan and for planning and evaluating other MDPH racial equity initiatives, including tools and workforce development programming aiming to dismantle institutional and structural racism. This Department-wide project has engaged staff (majority BIPOC) from across bureaus and offices and is being facilitated by the Performance Management and Quality Improvement Program within the Commissioner’s Office. Oversight of the project is through an Advisory Group (20+ staff participating) and Workgroup/subcommittee that have led the development of the survey content. Staff engaged in the project will pilot test and finalize the survey instrument and analysis plan, obtain necessary approvals, and deploy the survey electronically. It is anticipated that the survey will ask about staff self-reported competency in racial equity, behaviors around hiring, attitudes of leadership, approaches to their work, individual and institutional needs, work culture, and awareness and use of racial equity tools. A team of data analysts will be convened to analyze, interpret, and assist with the dissemination of the findings. Results will be used to identify areas for improvement for the Department overall, by bureau/office, and across demographic strata.

 

One of the goals of the REM Procurement Workgroup is to evaluate MDPH staff experience using the Racial Equity Principles, Guidance, and Level 1 Reviewer Training Slides. Feedback will be used to improve the accessibility and utility of the tools. The workgroup will also provide consultation and technical assistance (TA) to staff drafting RFRs and explicitly integrate racial equity into the existing Procurement 101 training for internal MDPH staff.

 

MDPH has been working with three consultants to create a sustainable infrastructure to support the REM. This includes conducting a landscape analysis of bureau and office racial equity work and ways to help move the work forward; assessing current resources to coordinate the two-day racial equity training, integration meetings, and follow-up training and practice labs; designing a process for staff and programs to request racial equity TA; building a pathway for staff to become racial equity facilitators; designing a process to track racial equity resources and best practices; and assessing current capacity for utilizing tools such as the Racial Equity Data Road Map and developing recommendations for implementation, performance measurement, and evaluation.

 

Racial Equity Data Road Map

MDPH leadership now promotes use of the Racial Equity Data Road Map and its integration into strategic plans and will continue to do so in FY24. The BFHN Racial Equity and Family Engagement Framework/Strategic Plan and the MDPH Strategic Plan 2023–2024 both include a focus on developing a data infrastructure to improve racial equity. The RESPIT team aims to revise and update the Road Map based on lessons learned from programs that have used it, including states participating in the DREAM-LC led by CDC and ASTHO and described in the FY22 Annual Report. MDPH has matched with a Title V intern team that will work with RESPIT in summer of 2023 to support this work. RESPIT will also work to ensure that guidance and principles from the Road Map are incorporated into MDPH grant applications and federal grant reports and ensure alignment of the Road Map with the Culturally and Linguistically Appropriate Services (CLAS) Manual chapters related to collecting and using data.

 

Objective 2. By 2025, increase the percent of BFHN staff of color from 36.8% to 42.6%.

BFHN is continuing refinement and testing of the Racial Equity and Family Engagement Strategic Plan Change ideas in the strategic plan that contribute to workforce justice, equity, diversity, and inclusion include:

• Develop a staff recruitment, inclusion, and retention plan with a specific aim to recruit and retain staff (especially in leadership positions) who speak the languages and are representative of the culture, race, and/or ethnicity, gender identity of the families we aim to serve.
• Revise job application requirements to reduce barriers to job entry (e.g., accept equivalent or lived experience for educational attainment, disclose the salary range, do not ask for salary history, remove names, addresses and schools from resumes).
• Establish a hiring process (job description responsibilities, interview questions, screening and selection criteria) that recognizes candidates for their sensitivity to and understanding of the root causes of racial inequities, as well as willingness to self-reflect on one’s own culture and listening skills.

 

The BFHN internal working group that developed the Hiring Process Job Aid and Onboarding Checklist to support hiring managers in centering racial equity in these processes will continue to promote awareness and use of the documents. Using a quality improvement approach, the team gathers regular feedback from hiring managers on these resources. User feedback will be used to continually improve the documents.

 

This work aligns with one of the focus areas outlined in the MDPH 2023-2027 Strategic Plan, which is to advance equity-centered workforce development. To meet its mission to promote and protect health and wellness with an emphasis in health equity, MDPH must have a strong organizational infrastructure built by a diverse and skilled public health workforce. The strategic plan outlines three objectives for this focus area: 1) utilize equitable practices to recruit and hire candidates with relevant professional and lived experience and expertise addressing racial inequities in health, across all roles within MDPH; 2) increase retention and reduce attrition within MDPH, with an emphasis on retaining colleagues with experience and expertise addressing racial inequities in health and increasing racial/ethnic diversity among senior leadership and managers; and 3) ensure all staff are skilled in, invested in, and committed to principles and practices of racial equity, with a particular focus on building racial equity capacity and accountability amongst senior leadership and managers.

 

Additional activities to eliminate institutional and structural racism in internal MDPH programs, policies, and practices

Culturally and Linguistically Appropriate Services (CLAS)

The Office of Health Equity (OHE) will continue to administer the CLAS Internal Assessment with all MDPH programs to identify areas for improvement and provide training and TA to staff and contracted vendors as needed. OHE will update the chapters in the CLAS manual on building community partnership using the racial equity lens. OHE will introduce the Budget for Equity Tool to the MDPH Accounting and Finance team early in the budget cycle to ensure programs allocate sufficient funding for language assistance services. In collaboration with other programs, standard procedures on how to budget, request and pay for American Sign Language/Communication Access Real-Time Transcription (ASL/CART) interpretation and translation were established and will be disseminated widely across the Department to leverage language justice. An online training module for CLAS 201 focusing on CLAS self-assessment for vendors will be completed and shared widely with MDPH staff who manage direct service contracts to ensure consistency in monitoring CLAS implementation across the Department.

 

Determination of Need Program (DoN)

The DoN program plans to: 1) update the current health care facilities language services Annual Report Survey to reflect post pandemic status and on-going changes in operations, services, policies, and procedures, 2) develop and conduct a survey to improve site visit reviews to further align MDPH requirements with facilities’ compliance and increase collaboration in planning and operations, and 3) increase site reviews by 50%.

 

Vaccine Equity Initiative (VEI)

The VEI activities officially ended in June 2023. The on-going work established in VEI including funding for community, faith, tribal, and rural organizations to support outreach and engagement activities, support for local boards of health, partnerships with community health workers (CHWs) and community health centers, and on-going data tracking and analysis was transition into existing DPH Bureaus and Offices to ensure sustainability.

 

Priority: Engage families, fathers and youth with diverse life experiences through shared power and leadership to improve MCH services.

 

Objective 1 (SPM 4). By 2025, increase to 50% from baseline (38.1% in FY19) the percent of Title V programs that offer compensated family engagement and leadership opportunities. 

Title V Family Engagement Implementation Team 

The Family Engagement Implementation Team will continue work on priority activities, including building aligned approaches to family engagement across Title V programs and supporting programs’ capacity to implement best practices for engaging families, with a focus on compensation. The Team has identified a training consultant to adapt the Family Engagement Framework modules for Title V staff and create opportunities for building skills and adapting existing program practices and will work to identify funding to support this activity. If funding is identified, the consultant will also develop a train-the-trainer guide to ensure Title V staff have the capacity to provide the modules on an on-going basis. Additionally, the Team hopes to partner with the consultant to develop a Community of Practice facilitator’s guide for Title V staff who have received the training to reflect on implementation challenges and lessons learn from their peers. The Team will also continue to develop a family engagement best practice guide that will be aligned with the training modules to support operationalizing the principles and approaches included in the Family Engagement Framework. The guide will include a menu of options for fairly and equitably compensating families for their involvement and leadership in Title V programs; a Continuum of Family Engagement tool outlining various levels of family engagement and providing Title V-specific innovative approaches and examples; and best practice reminders to ensuring equitable language and literacy access. Finally, the Implementation Team will continue to work together to gather feedback to improve and refine the Title V Family Engagement Survey that was restructured in FY23 to include an adapted FESAT self-assessment (see further description in Needs Assessment section).

Early Intervention Parent Leadership Project (EIPLP)

EIPLP will offer a fourth round of the training series Finding Your Footing: Using Your Family’s Experience to Impact Systems Change. Following a successful experience in FY22 of including three Portuguese speaking families in the training cohort, EIPLP will continue to recruit and support additional families whose primary language is not English. EIPLP will also work with community partners to recruit more fathers. Finding Your Footing graduates will be offered opportunities to use their skills in a variety of ways, including reviewing materials; participating on procurement teams; facilitating focus groups, meetings, and trainings; and serving on advisory councils. EIPLP will add trainings for families receiving EI services that include Emergency Preparedness, Family Rights in Early Intervention (EI), Telling Your Family Story, SSI & Public Benefits, and Early Intensive Behavioral Intervention (EIBI) Resources, as well as continuing collaboration with the Federation for Children with Special Needs in offering Turning Three Essentials four times a year in English and twice a year in Spanish. There will be opportunities for families to participate in reviewing the new procurement of EI services. This will include recruiting and training families to actively participate in the procurement review process.

 

Family TIES

Family TIES will continue to recruit, train and mentor parents for the Parent-to-Parent Program and administer the Share Your Voice program, reaching out to interested families with opportunities to serve as advisors to Title V program as opportunities arise. Family TIES will develop and deliver training about BFHN programs and eligibility criteria to community partners and will continue to operate an information and referral center to connect families with EI services and other community-based supports. The program will continue to share information in the top six languages spoken in Massachusetts to encourage families from diverse cultural and linguistic communities to connect with BFHN programs.

 

Two members of the Family TIES staff will share their family support subject matter expertise with MassHealth “CARES for Kids” providers as part of MA Title V’s new population-health model, the Care Coordination Assistance, Training, Education, and Resource (CCATER) Center. They will serve as family support specialists on CCATER care coordination training and TA (CC T/TA) teams with MDPH care coordination and clinical specialists. Activities targeted to family support specialists on CARES teams will include individual coaching calls, group learning collaboratives and communities-of-practice, in-person site visits, and T/TA resources and materials. The goal is to model and coach family engagement practices and to create a support system for family support specialists in community practices who may not have a peer group.

 

Universal Newborn Hearing Screening Program (UNHSP)

Family members represent two of the six positions in the program. The UNHSP expects to have an open position and will work to recruit either a deaf or hard of hearing person or a parent of a deaf or hard of hearing child. The UNHSP also actively recruits families for additional leadership opportunities offered by MDPH or through the LEND program. In addition, families will be supported to attend the in person Early Hearing Detection and Intervention meeting in Denver, CO.

 

Care Coordination

The Care Coordination program will continue using the MA Family Engagement Framework to reach out to and engage families and elevate their partnership with the systems of care. The program will continue to use a rubric to assess and track the continuum of a family’s development of knowledge and skills leading to increased success and self-sufficiency in accessing resources and navigating the system on their child’s behalf. The Care Coordination program will continue to plan activities that reflect partnership and are decided in accordance with family’s needs, expectations, and intended outcomes. Care Coordinators will continue to recruit and support family members, especially non-English speaking families, to attend the Federation for Children with Special Needs annual conference, the Mass Families Leadership Series, and other related leadership opportunities. The program will continue to offer activities for connection and training for parents in Spanish, English, Haitian Creole, Portuguese, and Cape Verdean Creole, the most common languages spoken in the program. The program will continue to implement targeted outreach for refugee and immigrant families (Vietnamese, Haitian, Afghan, and others).

 

MassCARE 

MassCARE will be transitioning to the Office of HIV/AIDS in the Bureau of Infectious Diseases and Laboratory Sciences under new leadership. The new Program Coordinator previously participated in the program as a youth and then parent consumer followed by serving as a hired peer for other program participants.

 

Pediatric Palliative Care Network (PPCN)

PPCN will initiate a statewide Family Advisory Council to inform program priorities and provide input on discrete projects. Through this engagement, parents/caregivers will have opportunities to contribute locally at the vendor program where their family is served.

Additionally, parents/caregivers and youth will be represented as experts, providing strategic input and education to vendor staff at program manager meetings and biannual statewide education conferences. Parent/caregiver and youth advisors will be compensated through stipends for their engagement.

 

Continued support and education will be provided for PPCN vendors on equitable hiring practices, DEI, and family engagement, with a commitment to standardizing benchmark measures in each of these domains. In addition to engaging families as advisors, program vendors will be encouraged and supported to provide opportunities for parent professionals interested in working in this field, professionalizing the lived experience when applicable.

 

Essentials for Childhood (EfC)

EfC will continue to engage and compensate family leaders on all collective impact teams, the Leadership Action Team, and the Community Governance Board at the new FY23-established rate of $40 an hour. Family leaders will also be compensated for their involvement in planning the new FY24 Notice of Funding Opportunity application and for their involvement in any current grant final reporting or culmination activities.

 

In addition, the EfC team will continue to support the final stages of refinement of the Community Governance Board. The activities and processes related to the Board’s structural development, planning, implementation, and lessons learned will be documented and developed into a process tool for inclusion into the Community Connectedness Toolkit, a final deliverable that will be submitted to the CDC at the culmination of the grant. The goal is that documentation of the Board’s development and implementation will be a helpful tool to support others who may be interested in developing Community Governance Boards as key operational elements to ensure community voice is forefront in making structural changes within public processes.

 

Young Children’s Council (YCC)

Through Title V funds and two newly awarded grants, the Pediatric Mental Health Care Access Project and Transforming Pediatrics for Early Childhood, MDPH is able to continue the family leadership efforts of the YCC. MDPH will continue to support the current cohort of nine family leaders and will seek to engage two male givers in the Council. The family leaders will continue to partner with MDPH staff to design meeting agendas, develop YCC newsletter content, and discuss additional leadership development opportunities based on the interests of the group, including presentations and facilitation of group discussions.

 

MA MIECHV 

MA MIECHV will continue to leverage lessons learned from the YCC, the Title V Family Engagement Implementation team, and the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) to support parent leadership in the planning, implementation, and improvement of program activities. MA MIECHV will continue to compensate families for their engagement and leadership at the state and local levels. MA MIECHV plans to recruit, support, and compensate parent leaders to advise program activities through a Parent Leader Panel.

 

MA MIECHV will host an Associate from the CDC Public Health Associate Program (PHAP) for a two-year placement (FY23 and FY24). Functioning as the MA MIECHV Family Engagement Coordinator, the PHAP will support efforts to engage families as partners contributing to home visiting programming at the state and local levels. Beginning in October 2022, the Associate joined the Title V Family Engagement Implementation team and the YCC to facilitate information sharing on family engagement best practices. The Associate will engage in cross-bureau discussions that guide MA MIECHV in implementing a strategic family engagement plan that incorporates the Massachusetts Family Engagement Framework’s strategies into training and program operations. The Associate will support MA MIECHV to use the results of the Title V Family Engagement Survey to reflect on current strengths, focus areas for improvement, and set SMARTIE[1] (specific, measurable, ambitious, realistic, time-bound, inclusive and equitable) aims.

 

MA MIECHV will continue engaging CQI Parent Leaders through MIECHV Innovation Award activities. CQI Parent Leaders include caregivers or parents of a child currently or previously enrolled in home visiting services who are interested in program improvement. CQI Parent Leaders will participate in a Learning Community focused on using CQI methods to identify and address inequities in MIECHV performance indicators disaggregated by race, ethnicity, language, and gender. They will work closely with LIA Teams to interpret the data, design data-driven solutions, and carry out action plans focused on advancing equitable access to and delivery of home visiting services. Partnering with families to interpret data, explore root causes of identified inequities, and design solutions will ensure that solutions are relevant and meet the needs of families.

 

Office of Sexual Health & Youth Development (OSHYD)

OSHYD will launch a youth advisory board to partner with OSHYD to redesign existing programs to best address the needs of the MA adolescents. Interested participants will be recruited from a pool of youth-serving agencies that deliver ASE, PREP, and STRIVE programming outlined in the Adolescent Health domain. OSHYD will interview a diverse group of candidates aged 15-24 years and select a cohort of ten youth to pilot the model. Transportation and lack of infrastructure are barriers that have prohibited OSHYD from implementing a youth advisory model in the past. To address these barriers, meetings will be virtual, and members will be based in and supported by local community organizations to ensure they are connected to a local agency to provide support for technology access, compensation, supervision, and mechanisms for fostering leadership skills. Advisory board members will be trained in racial equity principles, leadership, and experiential team building activities. The advisory board will provide an opportunity for young people to be compensated for their labor and expertise while simultaneously deepening OSHYD’s efforts to build and maintain relationships with youth constituents across the programs. Future projects may include development of public health campaigns for adolescents, social media campaigns, curriculum re-design, and developing guidance for youth-serving programs on creating youth-friendly spaces.  

 

The MA Pregnant and Parenting Teen Initiative will launch a statewide advisory board for parents under 25 in collaboration with the Department of Transitional Assistance. The goal of this advisory board is to engage parents to work in partnership with OSHYD/DTA to close gaps in services and address the needs of the parents under 25 population in Massachusetts.

 

Child and Youth Violence Prevention (CYVP) Programs

Positive youth development, and the engagement of young people in shaping the design and delivery of programs, is central to the work of the CYVP Unit. CYVP procured its youth violence prevention contracts, which began in FY23. The procurement has new requirements for youth leadership and family engagement, including requiring that all funded providers enhance their peer leader development programming. Youth who play leadership or staff roles in programs will continue to be compensated for their time. They will provide important perspectives to service providers and help engage youth and community members for community mobilization.

 

Perinatal Neonatal Quality Improvement Network (PNQIN)

Results from the PNQIN Massachusetts Hospital Perinatal Family Engagement Survey conducted in October 2022 demonstrate that there is considerable variation in family and community engagement across Massachusetts obstetric and neonatal hospital units. Hospital respondents also expressed a need for resources to help them strengthen and deepen their engagement activities. PNQIN will use these survey findings to inform planning for how to support hospitals in developing policies, practices, and initiatives to engage with families and communities. PNQIN will begin by convening a patient and family advisory council to co-develop projects and initiatives, including supports related to patient, family, and community engagement. PNQIN will support and integrate family members from diverse backgrounds into committees and workgroups so that the perspectives of pregnant and postpartum people with lived experiences inform PNQIN’s strategy and projects.

 

Fatherhood/Second Parent Experience

MDPH will pilot the Fatherhood/Second Parent Experiences survey in collaboration with Dr. Craig Garfield’s team at Ann & Robert H. Lurie Children’s Hospital of Chicago, who also worked on Georgia’s PRAMS for Dads pilot study. MDPH is actively developing all components of this project and planning to launch the survey in summer 2023 with six months of data collection. MDPH will support Dr. Garfield’s team to conduct data analysis and share findings in FY24–FY25. Upon successful completion of the pilot, MDPH will apply lessons learned and work to secure funding to implement the survey on an ongoing basis.

 

Priority: Eliminate health inequities caused by unjust social, economic, and environmental systems, policies, and practices.

 

Objective 1 (SPM 5). By 2025, decrease to 9.5% from baseline (12%, 2018-2019 NSCH) the percent of families who have had difficulty since their child was born covering basics, like food or housing, on their income.

Essentials for Childhood (EfC): Paid Family and Medical Leave (PFML) 

The MDPH PFML Team will continue to implement the data and outreach partnership with DFML. The team will support outreach of the benefit and seek understanding of the uptake and impact on health, well-being, and economic security of MA families, particularly considering the impact of the pandemic and families impacted by structural racism. Activities will include:

1. Data Analysis: Establishing a data use licensing agreement (DULA) between MDPH and DFML for linkage of DFML and MDPH birth certificate data to understand utilization of family and bonding leave and inform outreach, and linkage with PRAMS and PELL to analyze longer term health and other socio-economic impacts.
2. Outreach: Title V and EfC staff will continue to disseminate PFML informational materials through broad outreach strategies and establish targeted outreach and training opportunities to support knowledge of and access to PFML benefits. Specific activities will include finalizing and launching an Economic Benefits webpage on the DPH website of which one key benefit will be PFML; setting up training opportunities for DPH advisories and/or family support programs (e.g., WIC, home visiting, early education and care, and community action agencies) to learn the fundamentals of the PFML program and how to support families to apply online for the benefit; and working in partnership with DFML and the MDPH team implementing the CDC Preventing Adverse Childhood Experiences Data to Action Grant (PACE:D2A) grant to develop and implement a PFML public awareness campaign, particularly geared for under-resourced communities, to support knowledge of the benefit and the long term health benefits of paid leave, and highlighting the new family-friendly and language accessibility features.

 

Essentials for Childhood (EfC): Earned Income Tax Credit (EITC)

The EfC Economic Opportunity Team will continue to convene the MA EITC partnership of Boston Children’s Hospital, MASSCAP, ABCD Boston, and the Boston Tax Help Coalition to pilot the second year of the warm hand-off referral system between Children’s-affiliated pediatric practices and their neighborhood VITA sites. The team will complete an analysis of the second-year pilot data upon closure of the FY22 tax season. The partnership will use the results to inform next steps, understand utilization, and share the process to help other entities interested in launching a similar program.

 

In addition, EfC staff will continue to refine, develop, and implement activities to build EITC messaging, including disseminating the EITC tool for medical practitioners and launching the Economic Benefits page on the MDPH website. EfC staff will participate in the EITC Healthy Families Coalition and the Medical Tax Collaborative, as they pursue increased economic opportunity and poverty reduction policies for MA families. Staff will disseminate relevant eligibility information and other tax credit changes, such as the Healthy Families Tax Credits Coalition (formerly EITC Health Families Coalition), support mechanisms to increase access to tax credits, breakdown structural wealth inequities, and increase family financial, physical, and mental health. Specifically, the Coalition supports the increase of EITC state match from 30% to 40%, the increase of fiscal support for the state’s VITA sites, and the establishment of a Child and Family Tax Credit of $600 per dependent phased in over three years.

 

Essentials for Childhood (EfC): Community Connectedness

The EfC Community Connection Team will finalize the Community Connectedness Toolkit. This toolkit will include a range of tools including, but not limited to: tools that explain the value of community connection for families and promote ideas to create strong social connection; the EITC Tool, a resource for medical offices and professionals to bolster economic supports for patients; the economic benefits flyer for families; and processes to engage community members and allow power and resources to be shared with greater equity, including resources for racial justice affinity groups. EfC will disseminate the toolkit both within Massachusetts and to other states, and with communities or initiatives interested in replicating and testing these processes.

 

SSI and Public Benefits Training and Policy 

The Public Benefits and Health Policy Specialist will play an essential role in supporting DCYSHN’s work to eliminate health inequities by monitoring relevant policy development and initiatives and briefing Division leadership and issue-focused project teams. The specialist also will monitor changes in public benefits including those resulting from the end of the COVID-19 Public Health Emergency and will provide timely updates to Division staff and external partners. Among other venues, updates will be provided at the regional and statewide stakeholder collaboration meetings convened by the DCYSHN Care Coordination program. The specialist will participate as a member of external stakeholder coalitions including the Children’s Health Access Coalition and the Immigrant Healthcare Access Coalition and will serve on interagency bodies including the Department of Elementary and Secondary Education (DESE) Special Education Advisory Council and the EOHHS Families and Children Requiring Assistance (FACRA) Advisory Board. She will provide training and TA on public benefits internally to DCYSHN staff and to a broad range of external partners including health and social service providers, hospital staff, EI programs, staff of other state child- and youth-serving agencies, community-based organizations, school health staff and educators, parents/caregivers of CYSHN, and youth and young adults. The scope of training and TA has been broadened to encompass a range of public benefits addressing social determinants of health, Health Related Social Needs (HRSN) and health equity, in addition to the essential topics of SSI, MassHealth and maximization of health insurance. Examples include PFML and other caregiver supports, new MassHealth 1115 waiver services addressing HRSN, tax credits, benefits rules promoting employment, and benefits eligibility and barriers for children in immigrant families.

 

Occupational Health Surveillance Program (OHSP) 

One of the main goals of the OHSP is to address the needs of underserved workers, consistent with MDPH’s mission to reduce health disparities (occupational health equity). This is illustrated through equity-focused work in both surveillance and prevention domains. OHSP recognizes that the burden of work-related injuries and illnesses are not borne equally. For example, an analysis of workers’ compensation claims for workers aged less than 18 years showed that MA teens from neighborhoods with a higher percent of residents living in poverty were more likely to be injured at work. This finding underscores the importance of understanding the socio-demographic characteristics of neighborhoods where the most vulnerable worker groups, such as low-income workers, live and/or work and the multiple hazards faced by these groups at work and in the community. Young workers remain a key priority population for OHSP, and the program will continue related surveillance activities. 

 

Catastrophic Illness in Children Relief Fund (CICRF)

CICRF will continue to provide financial assistance to eligible families as well as information, referrals and TA related to accessing other financial supports. Staff will continue to build awareness with other state agencies, health care providers, community partners, family advocacy organizations, and families about the existence of the Fund as a potential financial resource, and work with other programs within the Division for Children and Youth with Special Health Needs to explore new ways to use technology and social media to reach community partners, referral sources and families.

 

To speed up the application review process, CICRF has invested substantial time and resources on quality improvement over the past few years. As a result of these efforts, CICRF will begin accepting online applications in July 2023 to make it easier for families to apply for financial assistance. The electronic application with a secure platform (REDCap) will allow families to upload necessary documentation. Initial feedback from families who have tested the new online application is that transmitting paperwork electronically is more convenient than copying and mailing documents to CICRF. Submission of the needed income and expense documentation with the application will shorten the review time by CICRF to determine eligibility for reimbursement, and families will know more quickly if they qualify for financial assistance. CICRF will develop a communication plan to build awareness of the transition to the new online application. The online application will be translated into English and Spanish initially, and CICRF will engage with families to both test and provide ongoing feedback during the transition from paper to electronic application process.

 

Division of Sexual and Domestic Violence Prevention and Services (DSDVPS)

DSDVPS-funded sexual and domestic violence agencies will continue to work to prevent and mitigate the impacts of sexual violence and IPV through a variety of strategies, including supporting families to access concrete supports and helping IPV survivors attain safety and well-being. DSDVPS-funded agencies will provide emergency shelter services, transitional housing services, shelter advocacy to help clients find emergency shelter, housing advocacy to help clients find and/or apply for housing, and economic advocacy.

 

Childhood Lead Poisoning Prevention Program (CLPPP)

CLPPP will continue delivering full case management services to lead poisoned children (blood lead levels [BLL] ≥ 10 mcg/dL venous) and pilot select services with families of children with BLLs between 3.5–9.9 mcg/dL in high-risk communities. This is in line with the CDC’s updated Blood Lead Reference Value of 3.5 mcg/dL and will include training and licensing of local health department staff to provide limited environmental investigations and code enforcement for families living in rental property. It will also include support from CHWs who will help coordinate service delivery for communities that are part of the pilot projects. Continued emphasis will be placed on restoring screening rates to 2019 levels. Working with local health departments and clinicians, CLPPP primary prevention and clinical care staff will develop strategies to increase screening rates in rural communities that have traditionally seen much lower screening rates compared to urban communities and to the state.

 

During the first half of FY23, CLPPP completed in-services with all five Early Education and Care (EEC) regions to discuss CLPPP services, lead screening, and environmental regulations. In FY24, CLPPP will continue to build this relationship with EEC, focusing on screening rate compliance and increasing referrals to EEC programs such as Head Start. CLPPP will also work with EI on a data sharing agreement to explore the adoption of a policy that would make lead poisoning an automatic eligibility for EI services.

 

CLPPP will also convene the Massachusetts’ Governor’s Advisory Committee (GAC). The GAC advises the CLPPP Director on matters of policy before the issuance of rules and regulations. The GAC comprises a range of stakeholders that includes two parents of children aged less than 6 years from low-income communities. CLPPP will work with the Bureau of Family Health and Nutrition to ensure these parents are compensated for their participation in the GAC. The group will discuss changes to federal regulations, which include CDC’s lowered blood lead reference value and EPA’s lead dust hazard and clearance standards.  

 

Care Coordination

The Care Coordination program for children and youth with special health needs will continue to support enrolled families with medically complex children with financial resources through its Family Support Fund. The Care Coordination program will provide resources, knowledge, and referrals to help families of children and youth with medical complexity address basic needs, housing, immigration, and other barriers to emotional, social, health, and economic well-being.

 

F.O.R. Families (Follow-Up Outreach Referral)

The FOR Families program will continue to assist families transitioning from homelessness to stable housing with securing basic needs such as healthcare, housing opportunities, childcare services, and financial resources. Home Visitors will educate participants and shelter staff about eligibility for entitlement programs. FOR Families will prioritize families with the most complex medical, mental health, substance use, safety, and child welfare concerns for weekly in-person visits.

 

MA Maternal Infant and Early Childhood Home Visiting (MA MIECHV) 

MA MIECHV will continue to provide TA to local agencies on strategies to support families affected by homelessness, such as designing visits to be held in community settings, supporting continuity of services where possible for families relocating, and exploring state and local resources that provide eviction prevention services. In addition, MA MIECHV will continue to explore state level partnerships to support families experiencing homelessness.

 

Lawrence Telehealth Kiosk/Cabina Video Salud

In FY24 Title V staff will continue to support the implementation, marketing, data collection, program improvement, and scalability of the Kiosk/Cabina Video Salud. A community meeting will be held in the summer of 2023 to convene original community-partners involved in the development of the kiosk to visit it, get updates on progress thus far, and discuss findings and recommendations from the TIER Community Evaluator project. The goal of the meeting is to collectively plan next steps based on evaluation findings and recommendations, including marketing and outreach strategies, understanding utilization, and considering purchasing and installing another kiosk in the city of Lawrence.

 

Priority:  Support equitable healing centered systems and approaches to mitigate the effects of trauma, including racial, historical, structural, community, family, and childhood trauma.

 

Objective 1 (SPM 6). By 2025, increase by 10% above baseline (to be established) the percent of agency/Bureau staff that report a workplace culture that reflects a safe and supportive environment to mitigate primary and secondary trauma.

Title V Healing-Centered Systems Implementation Team

Title V staff will continue to convene an implementation team to advance action plan activities for this priority that mitigate the effects of trauma, including racial, historical, structural, community, family, and childhood trauma. A priority is to conduct the agency wide Racial Equity Survey (See Objective 1, Racial Equity Movement) including questions on workplace culture, trauma, and healing to serve as a data source for this SPM. 

 

BFHN and BCHAP staff will continue to build an understanding of healing-centered engagement strategies and champion frameworks that foster racial equity and cultivate healing work environments. In collaboration with the agency’s Racial Equity Movement and staff responsible for agency-level strategic planning, implementation team members will help to ensure that the implementation of the strategic planning moves towards its vision of health equity for all by grounding the process in racial equity and healing centered engagement.

 

Objective 2. By 2025, develop a data dashboard that measures community, family and child factors that reflect equitable healing-centered systems of care that mitigate trauma at multiple levels.

In addition to efforts to improve internal policies, practices, and culture, another objective to measure progress on this priority is the development of a data dashboard that measures community, family and child factors that reflect equitable healing centered systems of care.

 

The PACE:D2A grant will continue developing an Adverse Childhood Experiences (ACEs)/Positive Childhood Experiences (PCEs) surveillance system to analyze indicators of resilience and healing and ACEs among the MCH population. The PACE:D2A Surveillance Team will continue to work closely with the Office of Population Health and MA DESE to establish a public-facing dashboard within the Population Health Information Tool (PHIT) that would allow communities to access ACEs/PCEs data to inform strategies to implement healing-centered approaches that promote PCEs and mitigate ACEs.

 

The PACE:D2A team will also continue partnering with MA DESE to explore the expansion of the YRBS sampling methodology to include alternative schools that are not traditionally a part of the sample population. Additionally, a new question will be included on the YRBS that assesses youth’s involvement with state agencies, such as the MA Department of Children and Families and the MA Department of Mental Health, to understand the prevalence of ACEs and PCEs in those population groups. These efforts are to ensure that our samples of youth are truly representative of all youth in the Commonwealth.  

 

Division of Sexual and Domestic Violence Prevention and Services (DSDVPS)

DSDVPS epidemiologists will analyze statewide data from the four indicators of resilience identified in the 2021 MA High School Youth Health Survey (YHS): percentage of youth who report that their neighborhood is safe or very safe; percentage of youth who report talking to an adult when they felt they needed to; percentage of youth who report being engaged in volunteer activities; and percentage of youth who report being involved in organized group activities (sports, youth clubs, etc.). The epidemiologists will create reports from these analyses for DSDVPS staff to inform training and TA and share them with community providers to inform work with MCH populations.

 

Additional activities to support equitable healing-centered approaches to address trauma

Additional efforts to address this priority that do not relate directly to the performance measure or other objectives are described below.

 

Division of Sexual and Domestic Violence Prevention and Services

DSDVPS programs will continue to incorporate trauma-informed approaches and healing-centered care into all aspects of their service provision. Because individual or community history of trauma is sometimes not explicitly known, trauma-informed approaches assume that every person may have been exposed to trauma, a practice like the concept of “universal precautions” in healthcare.  

 

MDPH-funded sexual and domestic violence agencies will continue to provide and track the number of sexual and intimate partner violence (IPV) clients who receive individual-level services. Through contract monitoring, DSDVPS will focus on program service data specific to populations known to be at heightened risk of victimization and/or to historically have experienced inequitable access to or quality of service. These data will inform training and TA plans at the individual agency level, at the statewide provider network level, and cross-program internal training with other MDPH programs. MDPH-funded agencies will continue to provide and track group services to survivors, including subpopulations who identify with specific racial/ethnic backgrounds, have disabilities, are homeless, are incarcerated, are from rural communities, identify as LGBTQ+, are experiencing substance addiction, or are teens.  

 

DSDVPS will continue implementing learning collaboratives comprised of professionals from the SDV fields that deepen professional learning around trauma-informed/healing-centered practice.

 

DSVPS-funded SDV agencies and TA providers will continue to gather and use data to inform the development of healing-centered practices. Surveys and community input meetings will be used to design TA and culturally tailored programming for high-risk groups to help mitigate the effects of trauma. In the FY22-25 grant cycle, survey findings will inform sexual and domestic violence services in LGBTQ communities.

 

DSDVPS plans to continue its close collaboration with OHE to increase access to SDV services for people with disabilities. DSDVPS and the OHE will implement a disability access online training that is being developed by the Massachusetts-based Institute on Human Centered Design. Both the online tool and the training video will be used to complete a detailed assessment of the physical accessibility of buildings and services for all MDPH-funded agencies across the entire Department. The tool cites both federal ADA standards for accessible design as well as, when applicable, more stringent requirements of the Massachusetts Architectural Access Board.

 

Division for Children and Youth with Special Health Needs

The Division will continue to build upon the professional development provided to staff on trauma-informed/healing-centered work practices by the Health Equity Manager through the sustainability materials they developed and provided. Emphasis will be placed on practical tools that can be immediately applied to combat burnout and compassion fatigue.

 

The Division’s new CCATER Center will include trauma-informed/healing-centered care in its training curriculum and TA services for participating MassHealth “CARES for Kids” total case management providers. CCATER will also operationalize and train provider care coordination and family support teams about the domains in the Blueprint for Change for CYSHCN, as well as other best practices such as Got Transition, Charting the Life Course, and the MA Family Engagement Framework.

 

Child and Youth Violence Prevention Programs

The Child and Youth Violence Prevention Unit continues to support programs in incorporating trauma-informed practices into their work. This includes providing trauma- and resilience-informed services, making the link between personal experiences of trauma and systemic oppression, and emphasizing collaboration, network-building, and action to address upstream drivers of trauma such as community engagement and mobilization activities.

 

 

[1] SMARTIE Goals Worksheet - The Management Center.